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Medicare Enrollment Periods

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Medicare is a federally sponsored health plan available to individuals age 65 and above who have qualified by working and paying Social Security or who have qualified through a spouse. Individuals younger than 65 can qualify through disability, or if they have end stage renal disease.

As the year comes to a close, it’s important to know how the enrollment periods work for Medicare recipients and to examine benefit options. There are four enrollment periods — initial, annual, open and special — and several different benefit options to consider.

Initial Enrollment Period
When an individual qualifies for Medicare and elects both Part A (hospital) and Part B (medical) coverages, this is the initial enrollment period. It begins three months prior to and ends three months after the eligibility month. During this period a qualifying individual may select any plan that is offered where they reside, and is guaranteed acceptance into any of the plans with no waiting periods or pre-existing condition limitations.

Annual Enrollment Period
This occurs November 15 through December 31 each year. During this period, Medicare recipients may make any changes to existing benefits. For example, if you currently have a Medicare plan without a prescription drug benefit, or are considering a Medicare Advantage plan, this is the time to add or change coverage.

Open Enrollment Period
During this period, which runs from January 1 through March 31, you are allowed to make one change to a different plan. However, unlike during the annual enrollment period, your change must be to a similar plan. For example, if you have a medical plan that does not include a prescription drug benefit, you must switch to a plan that also does not cover prescriptions, or vice versa.

Special Enrollment Period
This may occur any time during the year and is for situations such as developing a chronic condition, moving in or out of the service area of your plan, qualifying for Medicaid (known as AHCCCS in Arizona) or retiring from your employer and losing group health benefits. Any of these situations qualify you for a special enrollment, giving you the opportunity to change health plans during Medicare lock-in, which is from April 1 through December 31 each year.

Benefit Options
Plan choices are numerous and deserve careful consideration. Once you have elected Part A and Part B Medicare benefits, you may retain original Medicare only. With original Medicare there are deductibles to meet and cost sharing amounts to pay. You may wish to add a prescription drug plan (PDP), known as Part D, as a stand-alone plan to go with your benefits. A PDP must be purchased within six months of your Medicare eligibility or during the annual enrollment period. If you wait more than six months beyond your Medicare effective date, you may be subject to a lifetime penalty for late enrollment.
Medicare Supplement or Medigap plans can help pay for Medicare deductibles and many of the costs covered but not fully paid by original Medicare.  
                
Another increasingly popular choice is Medicare Advantage. You must be enrolled in both Parts A and B to enroll into one of these plans. The Medicare Advantage plans replace Medicare as your primary insurance coverage and are issued by insurance companies. Plan choices vary from Medicare HMOs and PPOs — which require that you use contracted providers — and private fee-for-service plans where you can use any Medicare provider who is willing to bill the insurance company and accept the payment terms and conditions. All plans include hospital and medical benefits, but may or may not include prescription drug coverage. 

The above information is meant as a general guideline to help you navigate through the difficult scenarios and choices available for Medicare beneficiaries. Having an expert who can help you make the best choice based on your situation is ultimately wise and can protect you from potential issues down the road. 

ASK AAA
AAA Arizona offers coverage through our preferred provider, Health Insurance Solutions, Inc. For more information, contact Terry Wiegel at 623-933-8569, 877-933-8569 or wedoinsurance@att.net and say that you are a AAA member.